Many clinicians are inadequately prepared to effectively "diagnose dying" or to discuss the likelihood of imminent death with patients and families. For the approximately 56% of all Americans who die in the hospital, studies also suggest that these patients may be at risk for overly aggressive care, may not receive adequate pain and symptom management, and clinical and family caregivers may not be fully informed about patients' wishes for care at the end of life. Understanding facilitators and obstacles to clinicians' recognition of and communication about the imminence of death is key to the design of effective interventions to improve care for imminently dying patients in the hospital and their families. Our primary aim is to use qualitative and quantitative methods of analysis to, (1) identify, among physicians (n=160) and nurses (n=19) who cared for patients (n=59) who died in the hospital, systematic and modifiable factors associated with recognizing and communicating (with patients, families, and the medical team) imminent patient death, and (2) assess the extent to which multiple accounts of care provided for the same patient are similar or different. We will address these aims through a secondary analysis of a unique dataset (response rate 80%) containing semi-structured and structured interviews and surveys with clinicians about their experiences and behaviors related to care for a random sample of patients who died in the hospital. Findings will be used to develop a prospective study that includes patient, family, and clinician perspectives to test hypotheses generated here, and to design a pilot intervention to enhance physician and nurse clinical practice with hospitalized patients near the end of life. [unreadable] [unreadable]